Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crowhall Medical Group on 15 March 2016. The overall rating for the practice was good. The full comprehensive report on the February 2016 inspection can be found by selecting the ‘all reports’ link for Crowhall Medical Group on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 27 February 2017 to the breach in regulation that we identified in our previous inspection on 15 March 2016. This report covers our findings in relation to that requirement and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings from this inspection were as follows:

• The provider had complied with the requirement notice we set following our last inspection visit. In particular, we found that Disclosure and Barring Service checks had been completed for all newly employed clinical staff.

In addition, the provider had also addressed most of the improvements we asked them to make. In particular, the provider had:

• Where relevant, arranged for staff to complete training in fire safety, infection control and the use of the Mental Capacity Act.

• Carried out an infection control audit and prepared an action plan to help drive improvements.

• Introduced a log to record the checks staff carried out to make sure emergency medicines were within their expiry date.

• Assured themselves that the defibrillator located in the healthcare centre was being appropriately serviced and calibrated.

• Actively considered what action they should take to introduce a system which would ensure that, where relevant, appropriate action was taken in relation to new clinical guidelines, or changes to existing ones.

• Reviewed their decision that GPs did not need to carry a range of emergency medicines for use in acute situations, when on home visits. The provider had reviewed their original risk assessment regarding this decision. Following this review, they had re-affirmed their decision that GPs should not carry emergency medicines on home visits.

However, there was also an area where the provider should make improvements. The provider should:

• Put a system in place which helps to ensure that, where relevant, new clinical guidelines, or changes to existing ones, are reviewed to see whether any changes are required to the practice’s systems, policies and procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection at Crowhall Medical Group on 15 March 2016. Overall the practice is rated as good.

• There was an open and transparent approach to safety and there was a good system for reporting and recording significant events. The staff team took the opportunity to learn from these events.

• The practice had a clear vision to deliver high quality care and promote good outcomes for their patients.

• Staff demonstrated a strong commitment to supporting patients to live healthier lives and were actively taking steps to achieve this.

• Outcomes for patients were . Data from the Quality and Outcomes Framework (QOF) showed that patient outcomes in the clinical and public health indicators were above average, when compared to the local clinical commissioning group (CCG) and England averages.

• Staff recruitment checks had not always been carried out effectively.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Staff had the skills, knowledge and experience to deliver effective care and treatment. Although some staff had not completed all of the required training for their role, arrangements had been made for them to do so.

• Staff had developed strong and effective working relationships with other healthcare colleagues, to help make sure the needs of vulnerable patients, and patients with complex health conditions, were met. The support clinical staff had provided to one of the care homes they supported had helped to significantly reduce admission rates to the local hospital, and contacts with the out-of-hours and community nursing teams.

• Patients said they were treated with compassion, dignity and respect and that they were involved in decisions about their treatment. Information about the services provided by the practice and how to complain, was available and easy to understand.

• The practice was well equipped to treat patients and meet their needs.

The areas where the provider must make improvement are:

• Ensure that required pre-employment checks are carried out and that there is documentary evidence to confirm this.

There were areas of practice where the provider needs to make improvements. The provider should:

• Review the need for GPs not to carry a range of emergency medicines for use in acute situations, when on home visits. Keep a written record of what the review considered and the outcome.

• Ensure fire safety drills are carried out regularly, and that staff complete fire safety training, in line with the practice’s fire safety policy.

• Put in place a formal system for updating the practice’s clinical guidelines.

• Ensure regular infection control audits are carried out.

• Keep a log of the checks staff carry out to make sure emergency medicines are within their expiry date.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The patients we spoke with were satisfied staff at the practice listened to their views, showed them respect and involved them in decisions about their care and treatment. Patients experienced care, treatment and support that met their needs and protected their rights. One patient told us, "It’s good here, if you need to see someone they fit you in. I’ve been to lots of practices, this is the best one. I’ve never had to wait a day to be seen." Another patient said, "You have enough time to sort out what you need."

Patients who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The premises were clean, hygienic and patients were protected from the risk of infection because appropriate arrangements had been made to prevent and control the spread of infection.

Effective staff recruitment and selection processes were in place. This meant steps had been taken to make sure only suitable staff were employed at the practice.